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The Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organisation (WHO) regularly report estimates for the prevalence of HIV and associated metrics for almost every country in the world. These statistics are essential for tracking the scale and the impact of HIV epidemic and are used routinely in the policy decisions and funding allocation decisions of national governments and international donors and therefore have a major impact on international public health. The methods underlying those estimates were originally developed, and continue to be refined and updated, by an international group of researchers at Imperial College London.
Rosengarten's work during the past fourteen years has provided the HIV field with new ways of rethinking otherwise seemingly intractable problems of more effective prevention. Despite over 30 years of biomedical and social research, and policy and programme implementation, the HIV epidemic continues to grow. The efficacies of repurposing potentially toxic and partially effective antiretroviral drugs for prevention in those perceived at risk of infection has thus come under scrutiny. It is in this context that Rosengarten's work has intervened and introduced an alternative approach to prevention that directly scrutinises the social contexts in which people live and work with HIV. Through this approach and her active engagement with clinicians, policy makers, scientists and advocacy groups she has contributed critical insights that have been incorporated into approaches to HIV prevention in practice.
Research conducted by Professor Jonathan Elford of City University London among people living with HIV in East London has had significant impact in the UK as a whole. The National AIDS Trust (NAT) used key findings from the research on employment, immigration and poverty in its submissions to the House of Commons. This led to:
Pre-eclampsia is a major contributor to death and disability in pregnancy. Diagnosis, based on accurate blood pressure (BP)/proteinuria determination, is limited by measurement errors and being late features of the disease. In collaboration with industry, King's College London (KCL) researchers have developed an inexpensive, accurate, simple BP device suitable for rural clinics. This device allows intervention to reduce mortality/morbidity and is currently being rolled out in a Gates Foundation project in Africa and Asia. KCL researchers have also helped the company Alere Inc. with the development of a diagnostically accurate test of placental growth factor (PlGF) in women with suspected pre-eclampsia: Alere Triage®PlGF. This demonstrates high sensitivity, superior to current tests, and following commercialisation is being adopted internationally. Their work is additionally reflected in guidelines of international standards for BP device accuracy.
The Unit's research into HIV testing has led to impacts on health policy (WHO and NICE guidelines) and services relating to HIV testing amongst vulnerable populations across Europe, and particularly, Scotland. The policies related to the frequency of HIV testing, increases in sites available for testing, and the scope of interventions to promote testing. These policies have contributed to significant increases in HIV testing, and a reduction in undiagnosed HIV infection, HIV related ill-health and AIDS deaths. For people living with HIV, this has enabled improved quality of life, better health and contributions to society.
Research carried out by LSHTM into the effects of male circumcision on HIV prevention has led to important policy recommendations by WHO and UNAIDS, the joint UN Programme on HIV/AIDS. The research showed a strongly reduced risk of HIV infection among circumcised men, and modelling studies estimated that male circumcision programmes in 13 priority countries in Africa could avert 4m HIV infections by 2025. Members of the research team serve on key international advisory groups, and these results have been widely used to underpin international policy guidelines.
Interdisciplinary research conducted in the School of International Development (2003-4) demonstrated for the first time high HIV prevalence and AIDS incidence among 0.5 billion people in fishing-dependent communities across the world. Subsequent research analysed the causes and suggested new strategies for development assistance and health service delivery. Dissemination of these insights to stakeholders generated significant post-2008 impacts on national government, international agency and NGO policies and programmes, contributing to improved access to prevention, treatment and care for hundreds of thousands of people. The research improved HIV/AIDS mainstreaming in natural resource sector governance and development programmes via training manuals, toolkits and policy briefs.
This case study focuses on impact that has occurred because of the research of faculty member Lucy Allais in the areas of disease and sexual health. Impact includes:
Highly Active Anti-Retroviral Therapy (HAART) is a combination of drugs used to effectively control HIV infection. Since 1987 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) had been used in HAART combinations to specifically target HIV-1 reverse transcriptase, however, resistance and side effects soon prompted the need for an alternative. In 1998, University of Oxford Professors David Stuart and David Stammers provided the first detailed structural framework to facilitate the design of a highly effective alternative class of drug, the Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). NNRTIs have since been developed for clinical use, impacting the pharmaceutical industry and profoundly improving the quality of life of patients.
Six million South Africans are currently infected with HIV and two million have died from AIDS- related diseases. Initially seen solely from a medical perspective, there is now recognition of social and cultural factors, such as witchcraft, that have shaped the pandemic. Niehaus's research findings, which have been disseminated beyond the academic domain, form part of a diverse body of social scientific literature on HIV/AIDS in South Africa. Niehaus's work has (i) enhanced cultural understandings; (ii) shaped public debate; (iii) contributed towards the training of health personnel; (iv) assisted the work of legal practitioners; and (v) assisted in the production of cultural artefacts.